Project Summary/Abstract Evidence-based diabetes monitoring & preventative services can prevent or delay many costly and highly morbid disease-related complications, yet many patients do not receive all clinically-meaningful, evidence- based services. For example, while detecting and treating early diabetic eye disease can reduce the development of severe vision loss by an estimated 60%, approximately 40% of Americans with diabetes do not receive an annual eye exam. Prior research has demonstrated numerous barriers to the completion of evidence-based diabetes monitoring & preventative services including patient factors (eg, lack of awareness and limited health literacy) and clinician/system factors (eg, limited physician time and patient support between visits). Attempts to increase diabetes monitoring & preventative services have had only modest results. To achieve optimal rates of these services, an intervention is urgently needed that improves clinical efficiency by decreasing clinician workload, is appropriate for patients with varying levels of health literacy, and is highly scalable and sustainable. By providing an engaging and convenient means to track and visualize health data, obtain education and guidance, receive notifications, and connect patients and doctors, patient portals offer a promising platform to enhance access to health services while overcoming the limitations of costly and difficult to scale face-to-face interventions. Our research team previously applied user-centered Design Sprint methodology to develop patient portal features and functionality that were engaging and satisfying for a diverse group of patients with diabetes to use and provided users with a better understanding of their diabetes health data (eg, A1C). Feedback from users indicated a desire to self-order and self-schedule services when they become due. Using a similar approach and with strong institutional endorsement, we will design, usability test, and evaluate a novel patient portal intervention to: (a) notify patients when selected, clinically-meaningful, evidence-based diabetes monitoring & preventative services (eg, annual eye exam) become due and provide reminders for timely completion, (b) promote understanding of the importance of these services through literacy sensitive content, and (c) allow patients, when due by evidence-based guidelines, to ?self-order? (requires primary care physician (PCP) single-click co-signature) lab tests (eg, A1C) and vaccines prior to doctor?s visits and self-schedule clinical services (eg, eye exam). Specifically, we aim to: (1) apply Design Sprint methodology and usability testing to design and test a patient portal intervention (described above) that can overcome patient and clinician/system barriers to completing evidence-based, clinically meaningful, diabetes monitoring & preventative services among a diverse group of patients, (2) evaluate the effect of the patient portal intervention developed in Aim 1 on the completion of those services in a pragmatic, cluster randomized controlled trial, and (3) assess PCP?s attitudes and experiences, through surveys and interviews, regarding the acceptability and usefulness of the intervention and its impact on clinical efficiency.